Do patients have recourse if they’re denied medical assistance in dying?

QUESTION: My father was in the advanced stages of prostate cancer and wanted a medically assisted death. He was told he needed the approval of two health care providers. One said yes, but the other said no because he “was not in any distress.” But that decision was so wrong. My father was a very stoic man, and was not one to complain. Did the doctor want him to break down in tears and beg to be put to death? My father passed away two weeks later in a hospice–instead of his home, the place where he wanted to die.

ANSWER: It has been over a year and a half since Parliament passed a law that makes medical assistance in dying–called MAID for short–legal across Canada.

The story you tell reflects one of the many challenges in creating a standardized system to handle these requests and to ensure that patients and their families are properly informed.

It’s impossible to say whether his assessors were unaware he had this option or simply failed to mention it.

Whatever the case, “we need to do a better job educating health care providers about what they must be disclosing to patients,” says Jocelyn Downie, a professor in the faculties of law and medicine at Dalhousie University in Halifax.

The federal law requires that patients undergo two independent medical assessments, which can be done by either doctors or nurse practitioners. The assessors determine if the person meets all the criteria for MAID.

For starters, a patient must be 18 years or older and mentally competent to make the decision.

The person must also have a “grievous and irremediable medical condition,” which is defined as:

A serious and incurable illness, disease or disability;

An advanced state of irreversible decline in capabilities;

Natural death is reasonably foreseeable;

The patient is experiencing physical or psychological suffering that is enduring and intolerable–and it can’t be relieved under conditions that the individual considers acceptable.

Certain requirements are fairly straightforward. Late-stage cancer would clearly meet the definition of an incurable illness.

But there is room for interpretation on some of the other eligibility criteria, says Sally Bean, an ethicist and policy adviser at Sunnybrook Health Sciences Centre in Toronto.

If your father was “stoic” and didn’t express his true feelings, the assessor may have thought, rightly or wrongly, that his suffering was tolerable rather than intolerable. In that case, the assessor might have deemed him ineligible for MAID.

During this review process, the assessor may have asked if palliative sedation would be acceptable to your father–he would essentially be made unconscious during his final days of life. If he agreed, the assessor might have concluded his suffering could be relieved by means acceptable to him and so he wouldn’t qualify for MAID.

Ms. Bean says some assessors could be reading the MAID requirements very narrowly. “They may be trying to follow the letter of the law and I can understand that approach, especially when dealing with an exception to the Criminal Code.” After all, ending a life outside of the context of MAID would still be considered a criminal offence.

However, she adds, there is an obligation on the part of the assessor to “make sure the patient is informed and understands why certain questions are being asked, what they mean and the implications” of how the person answers them.

The practice of medically assisted death is still relatively new in Canada and there’s likely to be some variation in how it is carried out, says Ms. Bean.

That variation, though, is expected to diminish over time with efforts to create a standardized approach.

“We are trying to establish best medical practices so there is consistency across the country,” says Dr. Stefanie Green, president of the Canadian Association of MAID Assessors and Providers (CAMAP) in Victoria, B.C.

“We realize this is a vulnerable time for patients and they may not be able to find MAID resources,” says Dr. Green. “If people are confused about MAID, they can get in touch with us through our website–camapcanada.ca–and we will direct them to an appropriate MAID coordination centre.”

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3 comments

Yes they have recourse. In their illness they have two choices, spend hundreds of thousands in court or go to Switzerland.
The law is not being upheld, period. Surprising that MAID keeps mentioning “straight forward diseases such as cancer”.
That is NOT what the law was set out for. Not those straight forward diseases.
Yes it’s simple, but not within the law that included a lot of people who are now denied by MAID. The “does not meet criteria” is convenient and somehow relies on a doctors final word,
Not on what is actually going on. The patients that requested, were denied and died? Well they get swept under the rug.
This law was about much more than having 6 weeks left.
To have doctors make it so narrow that many don’t qualify purely under their judgment is completely wrong and not according to law. It is simple, a doctor can decide for you how you will die. The final decision is not at all in the patients hands.

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